Contraception

 

ORAL CONTRACEPTIVES

How does the pill work?
Oral contraceptives work primarily by suppressing ovulation (the release of an egg from the ovary). They also thicken the cervical mucus (making it difficult for sperm to penetrate) and cause the uterine lining to be thinner (making implantation of a fertilized egg unlikely).

How effective is it?
Oral contraceptives are more than 97% effective in preventing pregnancy.

How is the pill taken?
Sunday start: Start the pill on the first Sunday after your period begins. If your period begins on a Sunday, start your pills that day.

First day: Start the pill on the first day of your menstrual period. Use the stickers provided in the pill pack to label your start day.

Take one pill at about the same time each day until you have taken the pills in one cycle pack. You should have your period sometime during the fourth week of pills. Always start your new pack of pills on the same day of the week. EXAMPLE: IF YOU STARTED CYCLE 1 ON A SUNDAY, YOU WILL START A NEW CYCLE 4 WEEKS LATER ON A SUNDAY. To prevent an unplanned pregnancy before the pills become effective use extra protection (i.e. condoms) during the first cycle of pills.

What if I forget to take my pill?
The effectiveness of oral contraceptives is dependent on taking the pill consistently every day, so pick a time of day that does not vary by more than 4 hours. Keep in mind your schedule on the weekends when choosing a time of day to take your pill.
If you miss one pill - Take the missed pill as soon as you realize you've missed it. Take the next pill as regularly scheduled. Take the pills with food to minimize nausea. Use a back-up method of birth control for at least seven days after the missed pill.
If you miss two pills in a row - Take two pills as soon as you remember and take two pills the next day. Take the pills with food to minimize nausea. Use a back-up method for at least 7 days after the missedpi lls.
If you miss 3 or more pills in a row - Stop the pill and wait for your next period. Begin a new pack of pills either as a Sunday start or the first day your period begins (see above).

What are the benefits of taking the pill?
The pill is a very reliable method of birth control and is convenient to use. Over 50,000,000 women use the pill, giving them greater control over their lives by freeing them from unintended pregnancies. In addition, there are many noncontraceptive benefits associated with OC use:

  • Reduced risk of ovarian and endometrial cancers.
  • Reduced risk of pelvic inflammatory disease (PID) and ectopic pregnancy.
  • More regular menstrual periods and lighter flow leading to less iron-deficiency anemia.
  • Less painful menstruation.
  • Decreased risk of benign breast disease.
  • Acne improvement.
  • Prevention and/or treatment of such conditions as endometriosis and polycystic ovarian syndrome (PCOS).

What are possible side-effects?

  • breast tenderness - usually mild and may disappear in a few months.
  • nausea - infrequent and may be minimized by taking the pill with food or at bedtime.
  • weight gain or loss - infrequent and usually less than 5 pounds.
  • spotting between menses - most often caused by forgetting to take one or more pills.
  • mood changes, headaches, depression.
  • vaginal yeast infections.

Are there any serious risks associated with pill use?
The serious risks associated with oral contraceptive use occur rarely. Serious risks, which can be life threatening, include blood clots, stroke or heart attacks. Cigarette smoking increases the risk of serious side effects, especially if you are more than 35 years old. Women who use hormonal contraceptives are strongly advised not to smoke. Women with the following medical conditions should not use the pill:

  • Blood clotting disorders or history of blood clots such as deep vein thrombophlebitis
  • Current or past history of heart disease or blockage of blood vessels
  • Severe high blood pressure
  • Diabetes with blood vessel complications
  • Headaches with focal neurological symptoms
  • Recent surgery with prolonged bed rest
  • Known or suspected cancer of the breast or personal history of breast cancer
  • Undiagnosed abnormal uterine bleeding
  • History of jaundice (yellow pigment to the skin) during pregnancy or with prior hormonal contraceptive use
  • Acute or chronic liver disease with abnormal liver function
  • Liver tumors or cancer
  • Known or suspected pregnancy

CAN I TAKE OTHER MEDICATIONS WHILE I AM ON THE PILL?
Certain drugs may interact with the pill to make them less effective in preventing pregnancy or cause an increase in breakthrough bleeding. Such drugs include Rifampin, drugs for epilepsy such as barbiturates (for example, Phenobarbital) anticonvulsants such as topiramate (Topamax), carbamazepine (Tegretol), phenytoin (Dilantin), phenylbutazone (Butazolidin), certain drugs used in the treatment of HIV or AIDS and possibly some antibiotics, With the exception of ampicillin and tetracycline, there is no known conclusive evidence that antibiotics in general do interfere with the effectiveness of hormonal contraceptives. There are however, anecdotal reports that women have become pregnant while using antibiotics but a cause and effect relationship has not been shown. The herb known as St. Johns Wort may also make the pill less effective.

As with all prescription products, you should tell your health care provider about any other medications you are taking. You may need to use non-hormonal back-up birth control methods when taking certain other medications. You may also need back-up if you have severe vomiting and/or diarrhea.

DOES THE PILL PROTECT ME AGAINST SEXUALLY TRANSMITTED INFECTIONS?
The birth control pill does not protect you from sexually transmitted diseases including HIV. Health Services recommends the use of latex condoms in combination with the pill to protect yourself from STDs.
DANGER SIGNALS: CONTACT HEALTH SERVICES IMMEDIATELY IF YOU HAVE ANY OF THE FOLLOWING SYMPTOMS:

  • Unusual pain or swelling in the arms or legs
  • Sharp chest pain or shortness of breath
  • Severe abdominal pain
  • Severe headaches
  • Sudden change in vision
  • Fainting or dizziness
  • Heavy, prolonged vaginal bleeding

Information associated with these serious risks is discussed in the detailed leaflet given to you with your supply of pills. Notify your provider if you notice any unusual physical disturbances while taking the pill.

Resources:
Managing Contraceptive Pill Patients, Richard Dickey, M.D., 10th Edition, 2000
Clinical Guidelines in Family Practice, Uphold and Graham, 3rd Edition, 1998

DEPO-PROVERA

What is DEPO-PROVERA?

DEPO-PROVERA is a hormone injection given every three months. This form of contraception provides a continuous release of progesterone (medroxyprogesterone acetate) which prevents ovulation. It also thickens the cervical mucus (making it difficult for sperm to penetrate) and causes the uterine lining to be thinner (making implantation of a fertilized egg unlikely).

How effective is it?
DEPO-PROVERA is more than 99% effective in preventing pregnancy.

When is the shot given?
DEPO-PROVERA is given by injection within the first five days of a woman’s menstrual cycle, or within five days of delivery if she is not breastfeeding. If given in this way, DEPO-PROVERA will be effective within 24 hours. It is then given every 12 weeks as long as continued contraception is desired, whether or not a woman continues to menstruate.

Where is the shot given?
DEPO-PROVERA is given in the muscle of the arm (deltoid) or buttocks.

Who should not receive the shot?
DEPO-PROVERA is not recommended for women who are pregnant or suspected of being pregnant. It is also not recommended for women who have a history of inflammation of the veins and/or blood clots, stroke, abnormal vaginal bleeding that has not been diagnosed, known or suspected malignancy of the breast or reproductive organ, liver disease or dysfunction, or known sensitivity to DEPO-PROVERA.

What are possible side-effects?

The most common side effect with DEPO-PROVERA is frequent, irregular bleeding or spotting. Some women miss their periods altogether. This is normal but if your pattern of bleeding concerns you, you can return to Health Services to discuss it. Another side effect is possible weight gain. Good nutrition and exercise will help you maintain your best weight. Occasionally some women complain of headaches or depression. DEPO-PROVERA may increase your risk of developing osteoporosis. You may need to increase your intake of calcium and Vitamin D.
You will need to have a medical history update and gynecologic exam at least once a year while using DEPO-PROVERA to make sure this method is suitable for you. Aminoglutethimide (Cytadren) diminishes the effectiveness of DEPO-PROVERA and it is advised that you use additional contraception if you are on this medication.

What are the advantages of the shot?
DEPO-PROVERA is safe, effective, long-term, reversible method of birth control. It is convenient. It is does not contain estrogen, which may be problematic for some women. It is a good method for women who would have difficulty remembering to take a daily pill.

Will the shot impact my ability to get pregnant in the future?
Your future fertility will ultimately be unchanged by DEPO-PROVERA. It may take, however, between 3 and 18 months after your last injection for your periods to return to normal and you can become pregnant. DEPO-PROVERA is not recommended for use if you intend to become pregnant in the next one to two years.

When should I contact Health Services?

Call Health Services immediately if you have any of the following symptoms:

  • Unusual pain or swelling in the arms or legs
  • Sharp chest pain or shortness of breath
  • Severe abdominal pain
  • Severe headaches
  • Sudden change in vision
  • Fainting or dizziness
  • Heavy, prolonged vaginal bleeding


Does the shot protect me against sexually transmitted infections?
DEPO-PROVERA does not protect you from sexually transmitted diseases including HIV. Health Services recommends the use of latex condoms in combination with DEPO-PROVERA to protect yourself from STDs.

 

EMERGENCY CONTRACEPTION “The Morning-After Pill”

What is Emergency Contraception?
Emergency contraception, also known as the “morning-after pill” or post-coital contraception, is used for prevention of pregnancy after unprotected vaginal intercourse (if a contraceptive fails or if no contraception was used). Health Services dispenses Plan B which contains levonorgestrel, a synthetic hormone (progestin) commonly used in birth control pills. The pills either prevent ovulation or change the uterine lining in such a way that makes implantation of a fertilized egg unlikely. These effects are temporary, only lasting a few days.

How effective is it?
Plan B reduces the risk of pregnancy following a single act of unprotected sex from about 8% down to 1%. This represents an 89% reduction in the risk of pregnancy for this single act of unprotected intercourse. It is more effective the sooner treatment is started following unprotected intercourse. It is not effective as a regular or main method of birth control. It is not effective in terminating an existing pregnancy.

How is Emergency Contraception taken?
Plan B consists of two tablets taken as soon as possible within 120 hours of unprotected intercourse. (Other emergency contraception methods may be prescribed which contain more pills.)

Who should not take Emergency Contraception?
Plan B is not recommended for women who are pregnant or suspected of being pregnant. It not recommended if you have any known allergy to progestin.

What are possible side-effects?
The most common side effect of Plan B is nausea. Less common side effects include abdominal discomfort, fatigue, headache, irregular menstrual bleeding, dizziness, breast tenderness, vomiting and diarrhea.
Theoretically, certain drugs such as anti-convulsants, barbiturates and the anti-tuberculosis drug, rifampin reduce the effectiveness of progestin. You should discuss this with your provider.

When should I contact Health Services?
Call Health Services immediately if you have any of the following symptoms:

  • Unusual pain or swelling in the arms or legs
  • Sharp chest pain or shortness of breath
  • Severe abdominal pain
  • Severe headaches
  • Sudden change in vision
  • Fainting or dizziness
  • Heavy, prolonged vaginal bleeding

    Follow-up is recommended if there is any doubt concerning your general health or pregnancy status. You should return to Health Services if you do not get your period when expected.


    Does Emergency Contraception protect me against sexually transmitted infections?
    Plan B does not protect you from sexually transmitted diseases including HIV. Health Services recommends the use of latex condoms to protect yourself from STDs.

    For more information about the Morning-After-Pill,
    please call Health Services, ext. 3476 
    from 8:30 a.m. to 4:30 p.m Monday through Friday while the college is in session.

    References: 1) Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomized trial, Lancet: Vol.360, Dec.7, 2002. 2) Uphold and Graham, Clinical Guidelines in Family Practice, Florida, 2003, p. 692-693. 3) Felicia H. Stewart, MD, Center for Reproductive Health Research & Policy, University of California, San Francisco (as presented at the ACHA annual meeting, Miami, May 2003) 4) Women's Capital Corporation: go2planB

    NCR